Provider Demographics
NPI:1962575423
Name:PACE COMMUNITY ACTION AGENCY, INC.
Entity type:Organization
Organization Name:PACE COMMUNITY ACTION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:AKIDA
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-882-7927
Mailing Address - Street 1:525 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1444
Mailing Address - Country:US
Mailing Address - Phone:812-882-6069
Mailing Address - Fax:812-886-5307
Practice Address - Street 1:715 WABASH AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3216
Practice Address - Country:US
Practice Address - Phone:812-882-6069
Practice Address - Fax:812-886-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100155290AMedicaid